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NPI Code Detail

MEDICARE: AMARYLLIS WELLNESS SERVICES, INC.

MEDICARE: AMARYLLIS WELLNESS SERVICES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency149015273IL

General Provider Information

NPI Number : 1467817262
Entity Type Code : Organization
Provider Name (Legal Business Name) : AMARYLLIS WELLNESS SERVICES, INC.
Provider Business Mailing Address
First Line : 1136 S DELANO CT W
Second Line : SUITE B201
City : CHICAGO
State : IL
Zip : 60605-3740
Country : US
Telephone Number : 312-572-9780
Fax Number :
Provider Business Practice Location Address
First Line : 1136 S DELANO CT W
Second Line : SUITE B201
City : CHICAGO
State : IL
Zip : 60605-3740
Country : US
Telephone Number : 312-572-9780
Fax Number :
Authorized Official
Title or Position : CEO
Name : JOYCE R WESTON
Credential : LCSW
Telephone Number : 312-572-9780
Provider Enumeration Date : 12/21/2015
Last Update Date : 12/21/2015

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